Early type 2 diabetes ups death risk in middle age

NEW YORK (Reuters Health) – People who develop type 2
diabetes before 20 years of age have higher rates of end-stage
renal disease, and higher mortality rates, when they reach
middle age than those who develop diabetes later in life, new
research shows.

Type 2 diabetes has been increasing among children and
adolescents in large part because of rising rates of obesity,
according to the report in this week’s Journal of the American
Medical Association. The impact of early-onset type 2 diabetes
on disease outcomes in adulthood, however, is unclear.

To investigate, Dr. Meda E. Pavkov, from the National
Institutes of Health in Phoenix, Arizona, and colleagues
analyzed data from a 37-year study of Pima Indians. This
population is very prone to develop type 2 diabetes, in some
cases as early as 3 or 4 years of age.

During follow-up, end-stage renal disease occurred at a
rate equivalent to 25 cases per 1000 persons per year among
those who became diabetic before age 20, the team found. That
was much higher than the rate of 5 cases per 1000 person-years
among those who developed diabetes between 20 and 55 years of
age.

Similarly, subjects with young-onset diabetes had a
natural-cause death rate of 15 deaths per 1000 persons per
year, roughly double the rate seen in those with older-onset
disease.

“The longer duration of diabetes mellitus by middle age in
individuals diagnosed younger than 20 years largely accounts
for these outcomes,” the researchers state.

“Because youth-onset diabetes mellitus leads to
substantially increased complication rates and mortality in
middle age, efforts should focus on preventing or delaying the
onset of diabetes,” they add.

SOURCE: Journal of the American Medical Association, July
26, 2006.